Articles: emergency-medicine.
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The use of ultrasonography in emergency medicine is an area of rapid growth and controversy. This article reviews the current and future applications of emergency ultrasonography with particular emphasis on the role of bedside scanning by the emergency practitioner. Abdominal, pelvic, and cardiac ultrasonographic applications are reviewed, as are the uses of ultrasonography as an adjunct to the performance of procedures in the Emergency Department.
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US is the imaging modality of choice in many situations encountered in the Emergency Department. It is particularly useful in evaluating renal colic, pain or vaginal bleeding in the pregnant patient, and pelvic pain in the nonpregnant woman; and in diagnosing gallbladder disease, appendicitis, proximal lower extremity DVT, and pericardial effusion. The information presented in each section, including sonographic findings and the role of US, should be helpful in choosing the most appropriate test in the evaluation process.
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Emergency physicians need an understanding of the utility of echocardiography in the Emergency Department. With the recent emphasis of emergency department use of portable ultrasonography, emergency physicians will have the opportunity to gain proficiency in using echocardiography to diagnose certain conditions. Echocardiography may aid in the diagnosis of acute MI, pericardial effusion and tamponade, acute valvular dysfunction, acute aortic dissection, and post-traumatic cardiac disorders. An understanding of the potential limitations of echocardiography, combined with experience in its techniques, will ultimately help the emergency physician with its use in daily patient care.
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In summary, Wrenn and Brody's [14] study raises important questions about the appropriate role of emergency physicians in discussing DNR decisions in the emergency setting. Their approach to DNR orders expands, appropriately we believe, the traditional role of emergency physicians. ⋯ In addition, emergency physicians have a heightened obligation to promptly address DNR status when appropriate decisions about resuscitation have been reached previously, as in the following cases: (1) when a clearly valid portable prehospital DNR order is in effect; (2) when the patient's primary physician clearly indicates to the emergency physician that the patient is DNR; (3) when an incompetent patient has an advance directive that explicitly precludes CPR and unquestionably applies to the current situation; (4) when a clearly competent, informed patient requests that a DNR order be entered. Finally, we advise emergency physicians against using the principle of futility as sole justification for DNR orders except in situations in which cardiopulmonary arrest is expected, and outcome data suggest that survival is virtually unprecedented.